Jaw Cysts Research Articles

Emulating Clinical Diagnostic Reasoning for Jaw Cysts with Machine Learning.

The detection and classification of cystic lesions of the jaw is of high clinical relevance and represents a topic of interest in medical artificial intelligence research. The human clinical diagnostic reasoning process uses contextual information, including the spatial relation of the detected lesion to other anatomical structures, to establish a preliminary classification. Here, we aimed to emulate clinical diagnostic reasoning step by step by using a combined object detection and image segmentation approach on panoramic radiographs (OPGs). We used a multicenter training dataset of 855 OPGs (all positives) and an evaluation set of 384 OPGs (240 negatives). We further compared our models to an international human control group of ten dental professionals from seven countries. The object detection model achieved an average precision of 0.42 (intersection over union (IoU): 0.50, maximal detections: 100) and an average recall of 0.394 (IoU: 0.50–0.95, maximal detections: 100). The classification model achieved a sensitivity of 0.84 for odontogenic cysts and 0.56 for non-odontogenic cysts as well as a specificity of 0.59 for odontogenic cysts and 0.84 for non-odontogenic cysts (IoU: 0.30). The human control group achieved a sensitivity of 0.70 for odontogenic cysts, 0.44 for non-odontogenic cysts, and 0.56 for OPGs without cysts as well as a specificity of 0.62 for odontogenic cysts, 0.95 for non-odontogenic cysts, and 0.76 for OPGs without cysts. Taken together, our results show that a combined object detection and image segmentation approach is feasible in emulating the human clinical diagnostic reasoning process in classifying cystic lesions of the jaw.

Awareness of Oral and Maxillofacial Surgery Specialty among Medical Students of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Oral and maxillofacial surgery is a relatively young surgical specialty with roots in dentistry and medicine. It has expanded with time from simple extraction of the tooth to the reconstruction of the facial deformity using microvascular free tissue transfer. Objectives: To find out prevalence of awareness of oral and maxillofacial surgery specialty among medical students of Birat Medical College and Teaching Hospital, Nepal. Methodology: A descriptive cross-sectional study was conducted from 1 September 2020 to 30 September 2020. A total of 100 medical students were chosen by convenience sampling method. A semi-structured questionnaire was developed in Google forms and sent to study participants through an internet link to assess the awareness of oral and maxillofacial surgery specialty. Data were analysed by Statistical Package for Social Sciences version 22. Results: The data showed that 81 (81%) of medical students have heard of oral and maxillofacial surgery specialty. Most of the students expected oral and maxillofacial surgeon for treatment of fracture of the lower jaw [86(86%)], upper jaw [89(89%)] and cheekbone [91(91%)]. Many students expected oral and maxillofacial surgeons to treat tumours of jaws [78(78%], cysts of jaws [77(77%)], temporomandibular joint disorders [74(74%)]. Few students expected oral and maxillofacial surgeon for dental implants [16(16%)] and lip repositioning surgery [4(4%)]. Conclusion: The majority of medical students have heard of Oral and maxillofacial specialty; however, they are not fully aware of the expertise and potentiality of the specialty.

An Atypical Presentation of Solitary Bone Cyst in Jaw: A Case Report

A solitary bone cyst (SBC) is an uncommon, benign cyst that primarily occurs in children and adolescents. They are pseudocysts primarily affecting long bones, with an incidence of 1% incidence among all the cysts of jaws. These cysts are generally detected during routine radiography, being asymptomatic. In this case report, we are presenting a case of SBC in mandible giving an unusual presentation.

Orthokeratinized odontogenic cysts: A clinicopathologic study of 159 cases and molecular evidence for the absence of PTCH1 mutations.

Orthokeratinized odontogenic cyst (OOC), a newly designated entity of odontogenic cysts, is an intraosseous jaw cyst that is entirely or predominantly lined by orthokeratinized squamous epithelium. The aim of this study was to report a large series of OOC to substantiate its clinicopathologic profiles and to investigate PTCH1 mutations in OOCs. The clinicopathologic features of 167 OOCs from 159 patients were analyzed and the immunohistochemical expression of markers related to cell differentiation and proliferation was evaluated. Furthermore, PTCH1 mutations were analyzed in 14 fresh samples of OOC. OOCs occurred mostly in the third and fourth decades (60.4%) with a male predilection (66.7%). The lesions developed more often in the mandible than maxilla, primarily in the posterior mandible and ramus. Eight patients (5.0%) showed multiple locations of either bilateral posterior mandible (n=6) or both the maxilla and mandible. Radiographically, the majority of OOCs (91.2%) showed a well-demarcated, unilocular radiolucency with 14 multilocular cases (8.8%). A follow-up of 131 patients (123 treated by enucleation with or without marsupialization and eight by peripheral ostectomy) revealed no recurrence during an average period of 4.56 years after surgery. Immunohistochemistry indicated lower proliferative activity and a varying epithelial differentiation pattern in OOC compared with odontogenic keratocysts (OKC). No PTCH1 mutation was detected, except for three known single nucleotide polymorphisms. The clinicopathological and molecular differences between OOC and OKC justified their separation, and unlike OKCs, OOCs did not harbor PTCH1 mutations, suggesting different pathogenesis underlying these two jaw cysts.

Radiographic bone volume alteration after jaw cyst enucleation with or without simultaneous bone grafts: A prospective randomized study.

This study was aimed to evaluate bone healing after jaw cyst enucleation with or without bone substitutes by cone beam computed tomography, and to analyze potential influence factors for bone formation as well. Sixty seven jaw cyst patients were randomly assigned to two groups. Thirty three patients in control group accepted cystectomy without any filling material. The rest 34 bone cavities which filled with xenograft (DBBM, Bio-Oss®) and covered by absorbable membrane (Bio-Gide®) were included in the guided bone regeneration (GBR) group. All patients were examined with cone bean computerized tomography before operation, 3 and 6months after surgery. Linear regression analysis was applied to evaluate the influence factors of bone healing. There was no significant difference in bone formation rate at 3months after enucleation, with shrinkage rate (SR) of cystic lesion in control group and GBR group of 26.43 ± 14.98% and 20.78 ± 10.80%, respectively (p > 0.05). Larger shrinkage area in GBR group was detected on postoperative radiographs after 6months with SR of 60.11 ± 19.23%, when compared to those in patients without filling (6months SR: 48.63 ± 19.39%, p=0.018, <0.05). Linear regression analysis showed that cyst size was negatively correlated with bone formation. GBR with bovine xenograft and absorbable membrane showed considerable bone regeneration property in the healing of jaw cystic defects after enucleation of radicular cysts. Cyst size showed a suppressive influence on bone formation.

Influence of the height of the alveolar bone in the distal parts of the upper jaw on the odontogenic inflammatory processes in the maxillary sinus

Aim: To determine whether the height of the alveolar bone affects the transmission of inflammation from the periapex of the tooth to the maxillary sinus. Background: The maxillary sinus is the largest of all paranasal cavities and is located in the body of the upper jaw. The inflammatory process in the teeth can often ascend to the maxillary sinuses and thus can cause odontogenic maxillary sinusitis. Untreated periapical inflammatory processes of the teeth in the distal parts of the upper jaw are the most common cause of odontogenic sinusitis. Data in the literature show that there is a correlation between the thickness of the mucosa of the maxillary sinus and the proximity of some anatomical structures, such as the height of the alveolar bone between the distal teeth of the upper jaw and the floor of the maxillary sinus. Methods: To accomplish the task, we analyzed 109 CBCT images of patients with odontogenic cysts of the upper jaw, located in the area below the floor of the maxillary sinus. In 61 of them the residual alveolar bone was less than 3 mm. For the other 48 it was over 5 mm. The group of teeth, included in the study, consisted of premolars and molars. Above each tooth with an odontogenic cyst, the thickness of the mucosa of the maxillary cavity was measured. For normal mucosa we considered thickness of 0 – 2 mm, and for pathological – thickness of over 2 mm. Group I – In this group we included odontogenic cysts in which the measured distance between the cystic cavity and the floor of the maxillary sinus was less than 3 mm. Group II – In this group we included odontogenic cysts in which the measured distance between the cystic cavity and the floor of the maxillary sinus was over 5 mm. Results: The following results were obtained in group I. Of the 61 cases with an odontogenic cyst present and alveolar bone height below 3 mm, the mean measured value in mm of sinus membrane thickness was 5.7 mm. The maximum value was 13 mm and the minimum was 2 mm. In group II we obtained the following results: we had 47 cases of radicular cysts of the distal teeth of the upper jaw, and the height of the bone to the floor of the maxillary sinus was 5 mm and more. The average thickness of the maxillary sinus mucosa was 2.21 mm. For comparison, up to 2 mm in the scientific literature is considered a healthy clinical mucosa. The minimum measured value was 1 mm and the maximum value was 8 mm. Conclusions: Based on the results obtained, we can conclude that there is a clear relationship between the thickening of the maxillary sinus membrane and the present periapical pathology of the maxillary distal teeth when they are close to or in contact with the floor of the maxillary sinus. This dependence increases with decreasing the volume of the residual alveolar bone.

Efficacy of bone grafts in jaw cystic lesions: A systematic review.

BACKGROUNDBone grafts have been applied for many years in orthopedic surgery to assist with bone repair for defects or bone discontinuity caused by trauma and tumors as well as periodontal defects. Jaw cysts are another common benign disease of the maxillofacial region which may lead to pathological bone fracture, loss of teeth, and infection. However, whether bone grafts are beneficial for bone regeneration in jaw cystic lesions and when bone grafts should be used remains unclear.AIMTo study the efficacy of bone grafts compared to spontaneous healing in the treatment of jaw cystic lesions.METHODSA literature search was performed in Medline, Cochrane Library and Embase to identify related articles published in English in the last ten years. The following key words and MeSH terms were used: “jaw cyst”, “cystic lesion”, “odontogenic cyst”, “periapical cyst”, “dentigerous cyst”, “follicular cyst”, “keratocyst”, “treatment”, “surgery”, “bone graft”, “enucleation”, “cystectomy”, and “bone regeneration”. Case reports, clinical trials, clinical studies, observational studies and randomized controlled trials were included. Study quality was evaluated.RESULTSTen studies (n = 10) met the inclusion criteria. Five studies reported spontaneous bone healing after enucleation, three studies investigated the efficacy of various bone grafts, and two randomized comparative studies focused on the comparison between spontaneous healing and bone grafting. Over 90% of bone regeneration occurred within 6 mo after bone grafting. The bone regeneration rate after cystectomy showed great variation, ranging from 50% to 100% after 6 mo, but reaching over 90% after 12 mo.CONCLUSIONWhile the long-term superiority of bone grafting compared with spontaneous healing after cystectomy is unclear, bone grafts accelerate the process of healing and significantly increase bone quality.

Enucleation combined with guided bone regeneration in small and medium-sized odontogenic jaw cysts.

BACKGROUNDThe odontogenic jaw cyst is a cavity containing liquid, semifluid or gaseous components, with the development of the disease. In recent years, with the rapid development of oral materials and the transformation of treatment of jaw cysts, more options are available for treatment of postoperative bone defect of jaw cysts. Guided bone regeneration (GBR) places biomaterials in the bone defect, and then uses biofilm to separate the proliferative soft tissue and the slow-growing bone tissue to maintain the space for bone regeneration, which is widely used in the field of implantology. AIMTo observe the clinical effect of GBR in repairing bone defect after enucleation of small and medium-sized odontogenic jaw cysts.METHODSFrom June 2018 to September 2020, 13 patients (7 male, 6 female) with odontogenic jaw cysts were treated in the Department of Oral Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. Adults without hypertension, heart disease, diabetes or other systemic diseases were selected. The diagnosis was based on the final pathological results: 11 cases were diagnosed as apical cysts, one as primordial cyst, and one as dentigerous cyst. The lesions were located in the maxilla in seven cases, and in the mandible in six cases. All cases were treated with the same method of enucleation combined with GBR. RESULTSThree to four months after the operation, the boundary between the implant site and the surrounding normal stroma was not obvious in patients with small-sized odontogenic jaw cysts. The patients with tooth defects were treated with implant after 6 mo. For the patients with medium-sized odontogenic jaw cysts, the density of the center of the implant area was close to the normal mass at 6 mo after surgery, and there was a clear boundary between the periphery of the implant area and the normal mass. The boundary between the periphery of the implant area and the normal mass was blurred at 8-9 mo after surgery. Patients with tooth defects were treated with implants at > 6 mo after the operation. CONCLUSIONEnucleation combined with guided bone regeneration in small and medium-sized odontogenic jaw cysts can shorten the time of osteogenesis, increase the amount of new bone formation, reduce complications, and improve quality of life.

Enucleation combined with guided bone regeneration in small and medium-sized odontogenic jaw cysts

Enucleation combined with guided bone regeneration in small and medium-sized odontogenic jaw cysts

Common Causes Of Jaw Bones Swelling Among Yemenis (A Prospective Descriptive Hospital Based- Study)

Objective: The aims of this study were to determine the common causes of jawbone swellings, common affected sites, the relationship of these causes to the age, gender of the patients and compare the findings of this study with many previous studies from various countries. Material and methods: The study design as a prospective descriptive hospital-based study, carried out at Al-gomhori teaching hospital in Sana'a Republic of Yemen. Material consists of 125 patients who attending to the department of oral and maxillofacial surgery and to the consultant unit of head and neck oncologic surgery and diagnosed clinically, radiographically as having jawbone swellings. Histopathological results of biopsy were used to confirm the diagnosis. Data; were collected from clinical examination of the patients (interview, inspection and palpation of the suspected swelling), patient history(using questionnaire sheet), radiographs and histopathological examinations. They entered the computer and analysis using statistical package for social science (SPSS) version 24. Results; were presented as simple frequencies and descriptive statistics. Chi-square test used to assess the association and the level of significance among categorical variables. P-value less than 0.05 were considered to be statistically significant. Results: Sixty eight of 125 patients(54.4%) were males and 57 (45.6%) were females, giving a male to female ratio of 1.2:1. Patients age ranged from 3 to 80 years with a mean age of 28.8 years ± 17.9 years. The majority of patients (80.0%) were in their 1st to 4th decades of life, with a peak incidence(40.8%) was found in the third and fourth decades of life. The most common causes of jawbone swellings were, jaw cysts, benign tumors (odontogenic and non-odontogenic tumor/tumor like-lesions) and malignant tumors, accounting 40.0%, 39.2% and 20.8% respectively. Conclusion: Jawbone swellings were observed more commonly in male patients, with a male to female ratio of 1.2:1 They may be found on any age of patients, with average age of 28.8 years (age range from 3-80 years). Jaw cysts were the most common causes of jaw bones wellings, following by benign tumors (odontogenic and nonodontogenic tumor/ or tumor lick-lesion) and malignant tumors which accounting 40.8%,39.2% and 20.8%.

Clinical Curative Effect Observation of Guided Bone Regeneration Combined with Curettage for Odontogenic Jaw Cyst

Clinical Curative Effect Observation of Guided Bone Regeneration Combined with Curettage for Odontogenic Jaw Cyst

Linewidths of Proton Nuclear Magnetic Resonance Peaks Obtained for Jaw Cysts and Abscesses at 400 MHz

Linewidths of Proton Nuclear Magnetic Resonance Peaks Obtained for Jaw Cysts and Abscesses at 400 MHz

Deep learning based diagnosis for cysts and tumors of jaw with massive healthy samples

We aimed to develop an explainable and reliable method to diagnose cysts and tumors of the jaw with massive panoramic radiographs of healthy peoples based on deep learning, since collecting and labeling massive lesion samples are time-consuming, and existing deep learning-based methods lack explainability. Based on the collected 872 lesion samples and 10,000 healthy samples, a two-branch network was proposed for classifying the cysts and tumors of the jaw. The two-branch network is firstly pretrained on massive panoramic radiographs of healthy peoples, then is trained for classifying the sample categories and segmenting the lesion area. Totally, 200 healthy samples and 87 lesion samples were included in the testing stage. The average accuracy, precision, sensitivity, specificity, and F1 score of classification are 88.72%, 65.81%, 66.56%, 92.66%, and 66.14%, respectively. The average accuracy, precision, sensitivity, specificity, and F1 score of classification will reach 90.66%, 85.23%, 84.27%, 93.50%, and 84.74%, if only classifying the lesion samples and healthy samples. The proposed method showed encouraging performance in the diagnosis of cysts and tumors of the jaw. The classified categories and segmented lesion areas serve as the diagnostic basis for further diagnosis, which provides a reliable tool for diagnosing jaw tumors and cysts.

A Novel Approach towards Automatic Contour Identification of Jaw Cysts from Digital Panoramic Radiographs to improvise the Treatment planning

Panoramic dental x-ray, a two-dimensional dental x-ray that captures the entire mouth in a single image, is used for the initial screening of various dental anomalies. One such is Jaw bone cyst, which, if not identified earlier, may lead to complications which in turn may lead to disfigurement and loss of function. Hence processing of radiographic images plays a vital role in identifying and locating the cystic region and extracting related features to assist clinical experts in further analysis. Objective: To develop an application of active contour model, known as Geodesic Active Contour, to generate Panoramic Dental X-Ray, a single 2 D X-ray image of the entire mouth highlighting the dental specifications. Methods: The process involves the image conversion from the OPG image into grayscale, Contrast adjustment using intensity level slicing, edge smoothing, segmentation, and cyst segmentation by Morphological Geodesic Active Contour to obtain the results. Hence processing of radiographic images plays a vital role in identifying and locating the cystic region. It is crucial in extracting related features to assist clinical experts in further analysis. Conclusion: When efficient and accurate diagnostic methods exist, the treatment and cure become easy and concrete. Based on the morphological snake and level sets, it aims at identifying the boundary by minimizing the energy. Results: Using the structural similarity index, an accuracy of 97.6% is obtained. Advances in Knowledge: This process is advantageous as it is simpler, faster, and does not suffer from instability problems. Morphological methods improve their functional gradient descent by improving stability and speed. The hysteresis algorithm exhibits better edge detection performance, a significant reduction in computational time and scalability.

The use of augmented reality technology in endoscopic removal of a maxillary cyst

This article describes the use of augmented reality technology for the removal of an odontogenic cyst of the upper jaw. By combining the image of computed tomography, anatomical formations and the tip of the endoscope in mixed reality, a navigation system was created for performing cystectomy and resection of the tip of the molar root for a volumetric cyst of the maxillary sinus. For the first time, a system for tracking the position of an endoscope in mixed reality in real time was used.

Удаление радикулярной кисты верхней челюсти с одноэтапной хирургической коррекцией структур полости носа

A radicular cyst is the most common odontogenic cyst. It gets its development from the periapical focus of infection that arose against the background of a complicated course of dental caries. In clinical practice, odontogenic cysts must be differentiated from other neoplasms of the maxillofacial region. One of the radiological signs of an odontogenic cyst is the presence of a bone shell with radiolucent contents. As a rule, the clinical manifestations of a radicular cyst are scanty, and the diagnosis is made on the basis of an X-ray examination, being an accidental finding. The article presents a clinical case of a radicular cyst of the upper jaw that grows into the maxillary sinus and pushes the lower wall of the sinus without violating its integrity. The cyst turned out to be an accidental finding during examination by an otorhinolaryngologist. The patient complained about the discharge of their nasal cavity, difficult nasal breathing. After performing computed tomography and joint examination of the patient by an otorhinolaryngologist and a maxillofacial surgeon, the diagnosis was formulated: curvature of the nasal septum, vasomotor rhinitis, radicular cyst of the right maxillary sinus from the 26th tooth. After the diagnosis and comprehensive assessment of the oral cavity and paranasal sinuses, surgical treatment was performed jointly by an otorhinolaryngologist and a maxillofacial surgeon with a satisfactory result. This case is of particular clinical interest in the practice of an otorhinolaryngologist and a maxillofacial surgeon preparing for dental implantological treatment of the oral cavity.

The use of augmented reality navigation technology in combination with endoscopic surgery for the treatment of an odontogenic cyst of the upper jaw: A technical report.

PurposeThis report presents the first known use of a rigid endoscope with augmented reality technology for the removal of an odontogenic cyst that penetrated the maxillary sinus and illustrates its practical use in a patient.Materials and MethodsIn the preoperative period, cone-beam computed tomography was performed in a specially designed marker holder frame, and the contours of the cyst and the nearest anatomical formations were segmented in the 3D Slicer program. During the operation, a marker was installed on the patient’s head, as well as on the tip of the endoscope, which made it possible to visualize the mass and the movement of the endoscope. The surgical intervention was performed with the support of augmented reality in HoloLens glasses (Microsoft Corporation, Redmond, WA, USA).ResultsThe use of this technology improved the accuracy of surgical manipulations, reduced operational risks, and shortened the time of surgery and the rehabilitation period.ConclusionWith the help of modern technologies, a navigation system was created that helped to track the position of the endoscope in mixed reality in real time, as well as to fully visualize anatomical formations.

Epidemiology, treatment, and recurrence of odontogenic and non-odontogenic cysts in South Sulawesi, Indonesia: A 6-year retrospective study

BackgroundDiagnosis of jaw cysts is challenging in general dental practice, and most cases are incidentally discovered through routine dental radiography. The aim of this study was to examine the epidemiology and treatment of odontogenic and non-odontogenic cysts to better understand the status of these lesions in populations in South Sulawesi, Indonesia. Material and MethodsThis retrospective study was conducted on patients treated at four different hospitals in Makassar between January 2011 and June 2017. Patients diagnosed as having odontogenic or non-odontogenic cysts were included in the study. Information on variables such as sex, age, histopathological, and anatomical distributions was collected. Statistical analyses were performed using an independent T-test and the Pearson chi-square test (p< 0.05). ResultsA total of 173 samples were collected, of which only 60 were histopathologically analyzed. The patients’ mean age was 30.3 years. The cysts occurred more frequently in women and in the anterior maxilla, followed by the posterior mandible. The radicular cyst was the most prevalent type, followed by the dentigerous cyst. Most cysts were treated with enucleation. Of the patients, 72.8% were followed up, of whom 3.2% had a recurrence and only 19.1% had complaints of clinical symptoms. ConclusionsOur findings indicate that odontogenic and non-odontogenic cysts widely vary in terms of incidence, with some exhibiting a predilection for specific ages and sites and specific sex. Knowledge of these factors could be useful for both clinicians and pathologists in the diagnosis and choice of the appropriate treatment plan. Key words:Cyst, epidemiology, odontogenic, non-odontogenic, treatment.

The role of neutrophils and platelets on the development and enlargement of jaw cysts

The role of neutrophils and platelets on the development and enlargement of jaw cysts

Research progress in the treatment of odontogenic jaw cysts

Odontogenic jaw cysts are clinically common benign lesions of the jaw. Traditional treatment modalities mainly include root canal therapy (RCT), marsupialization, cyst fenestration and drainage, scaling and partial jaw resection. Because of its different indications and advantages and disadvantages, there is still a need for improvement in traditional treatment modalities. Recently, the improvement of fenestration drainage, the combination of platelet-rich concentrates and bone filling materials, and the resection of odontogenic jaw cysts with deep location and difficulty in exploration under minimally invasive assisted techniques provide some reference for the treatment of jaw cystic lesions. This article reviews the various treatment methods and advantages and disadvantages of odontogenic jaw cysts in recent years.